Provider Demographics
NPI:1487242616
Name:ANSELL, AUDREY (RN)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ANSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 ISLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7587
Mailing Address - Country:US
Mailing Address - Phone:843-437-0550
Mailing Address - Fax:
Practice Address - Street 1:1189 SWEETGRASS BASKET PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7422
Practice Address - Country:US
Practice Address - Phone:843-856-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41257163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health